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Causes of Geographic Divergence in American Mortality Between 1990 and 2015: Health Behaviors, Health Care Access and Migration

1990 年至 2015 年间美国死亡率地理差异的原因：健康行为、医疗保健获取和移民

基本信息

批准号：
10442979
负责人：
IRMA T. ELO
金额：
$ 17.21万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-08-15 至 2023-03-31
项目状态：
已结题

项目摘要

PROJECT SUMMARY/ABSTRACT Coronavirus disease-2019 (COVID-19) is an international public health emergency caused by the respiratory droplet transmission of the coronavirus-2 (SARS CoV-2) virus. The United States has emerged as an epicenter of the pandemic, with distinctive regional patterning. To date, COVID- 19 mortality has largely been monitored using death certificates that contain reference to COVID- 19. However, prior analyses of excess mortality reveal that between 12% to 25% of excess deaths in 2020 were not directly assigned to COVID-19. The percent of deaths not assigned to COVID- 19 is also known to vary significantly by state and by county-level sociodemographic factors. However, it remains unknown to what extent excess mortality and excess mortality not assigned to COVID-19 differs by region and across the urban-rural continuum. The proposed Supplement will build upon and expand on current work on geographic inequalities in mortality by integrating a focus on COVID-19. Our preliminary work on excess mortality associated with COVID-19 has shown that mortality from COVID-19 and excess mortality not assigned to COVID-19 varies substantially across subsets of U.S. counties defined by their sociodemographic and health characteristics and along the urban-rural continuum. This preliminary work has also raised questions about the quality of the coding of causes of death across states and counties. The proposed supplement will enable us to expand our analyses to excess mortality and directly assigned COVID-19 mortality by geography and race/ethnicity. There is considerable evidence that excess mortality and COVID-19 mortality varies by race/ethnicity but little is known how the impact of the pandemic on the various U.S. racial/ethnic subgroups varies by geography. We will also investigate the potential impact of cause of death coding differentials on estimates of geographic inequalities in excess mortality and mortality directly assigned to COVID-19. Concerns about the quality of cause-of-death coding were also raised by the new report of the National Academy of Sciences, Engineering and Medicine, High and Rising Mortality Rates among Working-age Adults.

项目概要/摘要 2019 冠状病毒病 (COVID-19) 是由以下疾病引起的国际突发公共卫生事件冠状病毒 2 (SARS CoV-2) 病毒的呼吸道飞沫传播。美国有成为大流行的震中，具有独特的区域模式。迄今为止，新冠肺炎 - 19 死亡率很大程度上是通过死亡证明来监测的，其中包含有关新冠病毒的信息。 19. 然而，先前对超额死亡率的分析表明，12% 至 25% 的超额死亡 2020 年没有直接分配给 COVID-19。未归咎于新冠肺炎的死亡百分比众所周知，19 因州和县级社会人口因素而异。然而，目前尚不清楚超额死亡率和未分配的超额死亡率在多大程度上对 COVID-19 的认识因地区和城乡连续体而异。拟议的补充将通过整合现有的关于死亡率地域不平等的工作，建立并扩展当前的工作关注 COVID-19。我们针对与 COVID-19 相关的死亡率过高的初步工作研究表明，COVID-19 造成的死亡率和未分配给 COVID-19 的超额死亡率各不相同基本上涵盖了由社会人口统计和健康状况定义的美国各县子集特色和城乡连续体。这项前期工作还提出了关于各州和县死因编码质量的问题。这拟议的补充将使我们能够将分析范围扩大到超额死亡率，并直接按地域和种族/民族划分 COVID-19 死亡率。有相当多的证据超额死亡率和 COVID-19 死亡率因种族/民族而异，但很少有人知道如何这一流行病对美国各个种族/民族亚群体的影响因地理位置而异。我们将还调查了死因编码差异对估计的潜在影响超额死亡率和直接归因于 COVID-19 的死亡率存在地域不平等。担忧国家卫生研究院的新报告还提出了关于死因编码质量的问题科学、工程和医学科学院，死亡率高且不断上升工作年龄的成年人。